Provider Demographics
NPI:1316612823
Name:SANDSTROM, LINNEA ETOILE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINNEA
Middle Name:ETOILE
Last Name:SANDSTROM
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1904
Mailing Address - Country:US
Mailing Address - Phone:708-697-8865
Mailing Address - Fax:
Practice Address - Street 1:1630 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1904
Practice Address - Country:US
Practice Address - Phone:708-450-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2464002235Z00000X
IL146.016513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist